This is a basic surgical maneuver in most rhinoplasties of almost any kind, either primary or revisional, whenever, the nasal pyramid bones need narrowing at their junction with the maxilla at the nasal pyramid base or paramedial release from the osseous septum at the dorsum.
Open roof gap between the nasal bones and the osseous septum is an unavoidable consequence of dorsal resection, therefore it is mandatory to perform nasal bones infracture osteotomies to close it and prevent deformities requiring revision in the future.
Osteotomies can be either internal or percutaneous piercing the nasal skin with the chisel; due to the scars involved and the lack of precision of the percutaneous ones it is a total must osteotomies are performed internally.
It is carried out with precision chisel insertion performing the bone cut at the ascending maxilla and nasal bone, as well as, should it be required, at the synostosis or bone fusion between the osseous septum and the nasal bones.
This gesture can be done safely by either closed or open approach rhinoplasties.